APGAR Scores should be obtained at 1 Minute and 5 Minutes after Birth APGAR

Apgar scores should be obtained at 1 minute and 5

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Newborn transition & initial care occur in labor & delivery room. > APGAR Scores should be obtained at 1 Minute and 5 Minutes after Birth. APGAR Score is a rapid assessment of 5 physiological signs that indicate the physiological status of the newborn including A ctivity (Muscle Tone) Muscle Tone on degree of flexion & movement of extremities P ulse HR based on auscultation G rimace Reflex Irritability on response to tactile stimulation A ppearance Color on observation R espirations RR based on observed movement of the chest
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SEVERE Distress = 0-3 MODERATE Difficulty with transition to extrauterine life = 4-6 STABLE Status = 7-10 > Apgar Score is not used to determine need of resuscitation but it’s a rapid, objective, convenient shorthand for reporting the status of the newborn and the response of resuscitation after birth 31. Management of discomforts labor pg. 218 Gate Control Theory: Labor pain is Acute & is transmitted from the periphery of the body along nerve pathways to the brain. Uterine contractions from < in O2 supply to the uterus ^ pressure & stretching of pelvic structures Cervical Dilation/Stretching -> stimulation of the nerve ganglia 1st Stage of Labor - Pain is caused by Uterine muscle hypoxia Accumulation of lactic acid in the muscles Lower uterine and cervical stretching Traction on pelvic organs Pressure on the bony pelvis 2nd Stage of Labor - Pain is due to Pelvic muscle distension Pressure on the perineum, cervix, urethra and rectum > Back pain is thought to be caused by pressure of the fetal occiput on the maternal spine & pelvis > Pain is influenced by both physical & psychosocial factors 32. Pharmacologic & Nonpharmacologic pain relief pg. 219 Non-pharmacological Management of Labor discomfort includes: Preparation by the woman for childbirth Childbirth preparation classes Relaxation & Breathing Techniques: Deep breath at beginning of contraction -> breath slowly through contraction Cutaneous Stimulation Effleurage : lightly stroking the abd in rhythm with breathing during
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contractions Back massage “Counter Pressure” to sacral area of mother Thermal Stimulation Application of Warm/Cold : < catecholamine production which interferes with uterine contractility & Cold may < sensation of pain Mental Stimulation Focal points, Imagery, Music - focusing mother’s attention away from the pain Presence of support person Provide emotional support, comfort Doulas Pharmacological Management of Labor Discomfort > Requires nurse to assess the woman’s preference for pain management throughout labor A Pain Assessment needs to be completed 2 Med Categories Analgesics : labor should be established Meperidine (Demerol) : opioid Butorphanol (Stadol): opioid agonist-antagonist Sublimaze (Fentanyl): short acting opioid antagonist Anesthesia : Local: analgesic injected into perineum at episiotomy site Regional: Pudendal Block Epidural Block COMPLICATIONS W/ EPIDURAL: DECREASE BP & HYPOTENSION Spinal Block General Anesthesia : used in emergency c-section
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